Polynucleotides in London

What they are

Polynucleotides are chains of nucleotides, the building blocks of DNA, purified from a biological source and prepared for injection. The material used in cosmetic practice is generally derived from the milt of salmon or trout, chosen because it can be purified to a high degree and because its structure is similar enough to human DNA to be well tolerated.

The proposed mechanism is that these fragments support fibroblasts, the cells responsible for producing collagen and the surrounding matrix, and that they influence the local inflammatory environment. In practical terms the treatment is aimed at skin that is thin, crepey, dehydrated or poorly supported, rather than at shape.

Who they are used for

• Thin, crepey skin, particularly under the eyes where other options are limited.
• Overall skin quality where hydration and elasticity are the concern.
• The neck and décolletage.
• Skin that has been over-treated or that tolerates resurfacing poorly.
• As an adjunct alongside other treatments rather than as a replacement for them.

Not useful for volume loss, contour, deep static lines or significant laxity. Anyone with a known fish allergy should not have them, and any allergy history should be discussed carefully before the first appointment.

The under-eye question

This is where the category has attracted most attention, because the under-eye is difficult. Filler in the tear trough suits a narrow group and is dissolved frequently. Resurfacing is risky in such thin skin. Something that improves the quality and thickness of the skin itself, without adding volume, addresses a real gap.

That is the rationale, and it is a reasonable one. The caution is that the under-eye is still an area that retains fluid and shows everything, and that a treatment aimed at skin quality will not fix hollowing, fat prolapse or pigmentation. If your concern is a shadow cast by a hollow, read tear trough filler and consider whether the mid-face is the actual issue.

A treatment that improves the skin will not change the shape underneath it.

Protocol and what to expect

A course of three sessions two to four weeks apart is the usual pattern, sometimes more for the under-eye or for particularly thin skin. Product is delivered in small injections across the area, often with a fine cannula around the eyes to reduce bruising.

• Immediately after: small raised areas at the injection points, settling over hours.
• Days one to three: possible bruising, particularly under the eyes.
• Weeks two to four: hydration and comfort improve.
• Weeks six to twelve: the change in skin quality and thickness becomes apparent.
• Assessment several weeks after the final session, with photographs taken under consistent conditions.

Maintenance is generally discussed at six to twelve months. Because the change is gradual and subtle, standardised photography is more important here than in almost any other treatment; without it, you are comparing a result to a memory.

Risks

• Bruising and swelling at injection points, more likely under the eyes.
• Tenderness for a day or two.
• Small palpable areas that settle.
• Allergic reaction, which is why fish allergy is a contraindication.
• Infection, as with any injection.
• Disappointment, which is a real risk when expectations have been set by marketing rather than by an assessment.

How to have a sensible conversation about it

1. What specifically are you treating in my skin, and how will we know if it worked?
2. Which product are you using and what is the evidence for it in this indication?
3. How many sessions, and what does maintenance look like?
4. How will you photograph me, and under what conditions?
5. What would you expect this treatment not to change?
6. Would another treatment address my concern more directly?

The fifth question is the important one. A practitioner who can state clearly what a treatment will not do is a practitioner worth listening to about what it will. See the consultation.

How a newer treatment should be discussed

There is a pattern that repeats every few years in this field. A material arrives, early results are encouraging, marketing accelerates, and within eighteen months it is being offered for every indication by clinics that were not offering it at all the previous summer. Some of those treatments turn out to be genuinely useful and settle into practice. Others quietly disappear.

The way to sit sensibly inside that cycle is not to avoid anything new. It is to ask for the reasoning. A practitioner who can explain what the material is proposed to do, which findings in your skin they expect it to change, what they would expect it not to change, and how they will assess the outcome, is practising properly regardless of how new the treatment is. A practitioner who answers with a transformation and a package price is not.

It is also reasonable to ask what they used for this indication two years ago and why they changed. The answer is informative either way. Genuine reassessment in light of experience is a good sign. Changing because a distributor ran a training day is a different thing entirely.